Another disappointing result for Tecentriq in triple negative breast cancer

Anti-PD(L)-1 antibodies have a mixed record in triple negative breast cancer, and the failure of Impassion-131, a first-line trial of Roche’s Tecentriq, is another black mark. Tecentriq failed to improve PFS versus paclitaxel in PD-L1-positive patients, Roche said, while a negative trend on overall survival, a secondary endpoint, was detected. The trial was not sufficiently powered to show a benefit here and the data are still immature, but the study had already been upsized and the readout delayed, suggesting that the company was struggling to tease out even a marginal benefit. Tecentriq has accelerated approval in the US as a first-line treatment of TNBC in patients with least 1% PD-L1 expression, based on the Impassion-130 trial. This was similar in design to Impassion-131, but recruited more patients and used Abraxane instead of paclitaxel as the chemo comparator. There is some suggestion that paclitaxel could have made a difference: the high dose steroid premedication required to stave off side effects has been associated with diminished efficacy of immunotherapies. Tecentriq’s success in a neoadjuvant TNBC study earlier this year arguably makes the Impassion131 failure less important, but it is clear that there is still much to be learned about the drug's role in this disease.